Knowledge-based automatic image segmentation

ABSTRACT

A method for medical image segmentation includes accessing and updating a knowledge-base. A medical image is received and a sparse landmark signature is computed based on the medical image. Either a representative or a cohort average reference image set is selected. A portion of either representative reference image set or the cohort average reference image set is deformed to generate mappings to the medical image set. A segmentation for each structure of interest of the medical image set is determined. The knowledge-base is searched for representative matches to form a plurality of sub-volume base sets comprising a plurality of reference image set sub-volumes. A portion of the plurality of reference image set sub-volumes is deformed to generate mappings from the plurality of sub-volume base sets to corresponding structures of interest of the medical image set. A weighted-average segmentation for the structures of interest in the medical image set is calculated.

CROSS-REFERENCES TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No. 13/069,004, filed Mar. 22, 2011, U.S. Pat. No. 9,020,216, hereby incorporated reference in its entirety, which in turn is a continuation-in-part of and claims priority to pending U.S. application Ser. No. 12/845,358, filed Jul. 28, 2010.

TECHNICAL FIELD

The present disclosure relates generally to the field of automatic image segmentation and more specifically to the field of medical image automatic segmentation configured for medical applications.

BACKGROUND

When medical imaging is necessary to observe an internal organ or a set of internal organs, there are several systems that may be utilized: X-ray, magnetic resonance imaging (MRI), computed tomography (CT), and others. When CT or MRI imagery, for example, is used, a series of two-dimensional images are taken from a three-dimensional volume. Here, each two-dimensional image is an image of a cross-sectional “slice” of the three-dimensional volume. The resulting collection of two-dimensional cross-sectional slices can be combined to create a three-dimensional image or reconstruction of the patient's anatomy. This resulting three-dimensional image or three-dimensional reconstruction will contain the desired internal organ. This portion of the three-dimensional image or reconstruction that contains the structure of interest may be referred to as a volume of interest. Note that when it is desired to observe multiple internal organs, there will then be a plurality of structures of interest as well.

These one or more structures of interest may be viewed in several ways. A first and simplest way to view the structure(s) of interest would be to merely view the original CT or MRI image slices for the patient, with each slice containing a view of the structure(s) of interest. A second, and more complicated method to view the structure(s) of interest would be to combine the series of two-dimensional cross-sectional slices into a single three-dimensional representation where the structure(s) of interest may be represented as solid, opaque, or translucent, etc., objects that may then be manipulated (e.g., rotated) to allow viewing from multiple angles.

One purpose of the three-dimensional reconstruction of the structure(s) of interest containing diseased or abnormal tissues or organs is the preparation of a three-dimensional radiation therapy treatment plan. Radiation therapy treatment plans are used during medical procedures that selectively expose precise areas of the body, such as those containing cancerous tumors, to specific doses of radiation to destroy the undesirable tissues. To develop a patient-specific radiation therapy treatment plan, information is extracted from the three-dimensional model to determine parameters such as organ shape, organ volume, tumor shape, tumor location in the organ, and the position or orientation of several other structures of interest as they relate to the affected organ and any tumor.

The two-dimensional slices may be individually viewed on a computer screen and with the use of conventional graphics programs, the contours of organs or structures of interest can be traced out by hand. Contours are connected line segments that define the outline of a structure of interest, which may be an organ, a portion of an organ, a tumor, diseased tissue, or a whole patient outline. Alternatively, these structures of interest in specific organs such as the brain or prostate, for example, may be identified with various structure-specific automatic contouring and/or automatic segmentation software programs (subdividing an image into discrete regions) that outline or fill the shape of the structure of interest on each two-dimensional slice of a set of slices.

SUMMARY OF THE INVENTION

This present invention provides a solution to the challenges inherent in medical image automatic segmentation. In a method according to one embodiment, a series of steps provide knowledge-based medical image automatic segmentation. After receiving a medical image, a knowledge-base is searched for a representative reference image set. A portion of the representative reference image set is deformed to generate mappings from the representative reference image set to the medical image. A segmentation for each organ of interest is calculated. In one embodiment, the segmentation for each organ of interest is used as a seed for an automated structure-specific segmentation algorithm. In another embodiment, after the automatic segmentation algorithms are complete, reviewed and corrected as necessary, the medical image and its associated meta-data, sparse landmark signatures and structures of interest are added to the knowledge-base.

In a method according to another embodiment, after receiving a medical image, the knowledge-base is searched for a cohort average reference image set, wherein the knowledge-base includes at least one cohort average reference image set. A portion of the cohort average reference image set is deformed to generate mappings from the cohort average reference image set to the medical image set. Finally, a segmentation for each structure of interest in the medical image set is determined.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will be better understood from a reading of the following detailed description, taken in conjunction with the accompanying drawing figures in which like reference characters designate like elements and in which:

FIG. 1 is a simplified block diagram illustrating a system for providing knowledge-based medical image automatic segmentation, in accordance with an embodiment of the present invention;

FIG. 2 illustrates steps of an example process for knowledge-based medical image automatic segmentation, in accordance with an embodiment of the present invention;

FIG. 3 illustrates steps of an example process for knowledge-based medical image automatic segmentation, in accordance with an embodiment of the present invention;

FIG. 4 is a simplified block diagram illustrating images sets for a knowledge-based medical image automatic segmentation, in accordance with an embodiment of the present invention;

FIG. 5 illustrates steps of an example process for knowledge-based medical image automatic segmentation of a cohort of reference image sets in the knowledge-base, in accordance with an embodiment of the present invention;

FIG. 6 is a simplified block diagram illustrating knowledge-based medical image automatic segmentation in accordance with an embodiment of the present invention;

FIG. 7 is a simplified block diagram illustrating knowledge-based medical image automatic segmentation in accordance with an embodiment of the present invention;

FIG. 8 illustrates steps of an example process for knowledge-based medical image automatic segmentation in accordance with an embodiment of the present invention; and

FIG. 9 illustrates steps of an example process for knowledge-based medical image automatic segmentation in accordance with an embodiment of the present invention.

DETAILED DESCRIPTION

Reference will now be made in detail to the preferred embodiments of the present invention, examples of which are illustrated in the accompanying drawings. While the invention will be described in conjunction with the preferred embodiments, it will be understood that they are not intended to limit the invention to these embodiments. On the contrary, the invention is intended to cover alternatives, modifications and equivalents, which may be included within the spirit and scope of the invention as defined by the appended claims. Furthermore, in the following detailed description of embodiments of the present invention, numerous specific details are set forth in order to provide a thorough understanding of the present invention. However, it will be recognized by one of ordinary skill in the art that the present invention may be practiced without these specific details. In other instances, well-known methods, procedures, components, and circuits have not been described in detail so as not to unnecessarily obscure aspects of the embodiments of the present invention.

Notation and Nomenclature

Some portions of the detailed descriptions, which follow, are presented in terms of procedures, steps, logic blocks, processing, and other symbolic representations of operations on data bits within a computer memory. These descriptions and representations are the means used by those skilled in the data processing arts to most effectively convey the substance of their work to others skilled in the art. A procedure, computer executed step, logic block, process, etc., is here, and generally, conceived to be a self-consistent sequence of steps or instructions leading to a desired result. The steps are those requiring physical manipulations of physical quantities. Usually, though not necessarily, these quantities take the form of electrical or magnetic signals capable of being stored, transferred, combined, compared, and otherwise manipulated in a computer system. It has proven convenient at times, principally for reasons of common usage, to refer to these signals as bits, values, elements, symbols, characters, terms, numbers, or the like.

It should be borne in mind, however, that all of these and similar terms are to be associated with the appropriate physical quantities and are merely convenient labels applied to these quantities. Unless specifically stated otherwise as apparent from the following discussions, it is appreciated that throughout the present invention, discussions utilizing terms such as “processing” or “accessing” or “executing” or “storing” or “rendering” or the like, refer to the action and processes of a computer system, or similar electronic computing device, that manipulates and transforms data represented as physical (electronic) quantities within the computer system's registers and memories and other computer readable media into other data similarly represented as physical quantities within the computer system memories or registers or other such information storage, transmission or display devices. When a component appears in several embodiments, the use of the same reference numeral signifies that the component is the same component as illustrated in the original embodiment.

This present invention provides a solution to the increasing challenges inherent in medical image automatic segmentation. In particular, various embodiments of the present disclosure provide automatic segmentation of a patient's two-dimensional medical images through the use of a knowledge base comprising a plurality of reference image sets, wherein each reference image set comprises a plurality of two-dimensional slices. Each slice in a reference image set has been segmented and contoured, with each structure of interest (e.g., organs, tumors, diseased tissues, etc.) labeled. As discussed in detail below, a plurality of reference image sets with similarities (e.g., similar sparse landmark signatures) to the medical image set are selected to form a base set and each deformed with a deformable image registration algorithm to generate mappings from the selected reference images to the medical image. Segmented structures of interest in each selected reference image are also deformed to the medical image to generate mappings to the medical image. A weighted average segmentation for each organ of interest is calculated, wherein the weighted average segmentation for each organ of interest is used as a “seed” for structure-specific automatic segmentation algorithms. After the automatic segmentation algorithms for each structure of interest are complete, the results are reviewed and contours are corrected as required. After approving the medical image, the medical image and its associated meta-data, sparse landmark signatures and structures of interest are added to the knowledge-base.

Medical Image Segmentation

As is well known in the art, image segmentation is a process for reviewing a digitized medical image, and based on the merits of the medical image, differentiating or identifying structures of interest and labeling them. For example, when reviewing a medical image of the thorax, using image segmentation, a line can be drawn around a section of the image and labeled as “lung.” In other words, everything within the line is deemed lung, and everything not inside the line is deemed not lung. Image segmentation is utilized in radiation therapies, where a practitioner needs to precisely define where the radiation treatment is to be placed and just as importantly, where the radiation treatment is not to be placed. A structure of interest may be defined as: an organ; a tumor; diseased tissues; and bones visible in the medical image, for example. CT and MRI scans, as mentioned above, are common medical image modalities. However, any two-dimensional image may be segmented where a practitioner is interested in differentiating between structures of interest in the image. In CT and MRI scans where a plurality of slices is generated, segmentation is usually performed on each slice in turn. For the sake of convenience and simplicity, segmenting a CT scan, for example, refers to segmenting each slice in turn.

Medical image segmentation is used with, for example, IMRT (intensity modulated radiation therapy), to paint radiation, or shape the radiation in the body to conform to the tumor. Segmentation is a core benefit: when a radiation treatment may be shaped so as to conform to a tumor, critical organs can then be avoided. Rather than merely fitting or shaping the radiation therapy to fit the tumor, critical organs, such as the brain stem, for example, can be avoided. An exemplary radiation therapy utilizes pencil beams of radiation, placing radiation into the body at targeted locations. However, to do that, the computer running the IMRT treatment needs to know where the brain stem is. Treatment planning software for the IMRT takes medical images (e.g., CT or MRI data sets) and identifies all the organs or structures of interest at risk (especially those structures that are sensitive to radiation or that must not be irradiated regardless of their radiation sensitivity). Further, those structures of interest that are targets for the radiation therapy are also identified. The structures as drawn on the individual slices are combined into volumes of interest, spanning multiple slices. Given the volumes drawn and the doses prescribed for each volume identified, the treatment planning software will calculate the best method for putting the dose in.

But as medical imaging resolution increases providing additional slices, and the number of structures that must be identified, as well as the precision with which they must be identified increases, the treatment planning process takes longer. This is especially apparent when each slice must be segmented by hand. However, even with automatic segmentation algorithms currently available, the practitioner is still often required to manually drop the seeds into the image, and must review each slice individually. “Dropping a seed” is a process whereby a practitioner selects points within an area of a medical image and identifies them as part of a particular structure of interest (e.g., a prostate, bladder, or femur). Therefore, an excessive amount of time can be spent manually seeding each medical image. However, even after seeding the automatic segmentation algorithms, the practitioner is often required to edit the segmentation and contouring results to correct them. This editing is required as the automated segmentation results will commonly produce some segmentation and/or contouring errors requiring practitioner editing to correct. The end result is that even with automatic segmentation software tools, the time required is often little better than manually segmenting, with the necessity to drop seeds and then frequently spend a significant amount of time editing to correct the autosegmentation and autocontouring software results.

Automatic segmentation is further complicated by the fact that automatic segmentation tools are often tailored to be structure specific, such that they only work well on certain internal organs. For example, an automatic segmentation tool utilizing edge detection has difficulty in automatically individually segmenting the bladder and prostate, because they can't be individually differentiated. When the bladder is full and touching the prostate, the prostate-bladder barrier can't be seen. The end result is difficulty in determining where one ends and the other one begins. Instead, automatic segmenting tools for the prostate are forced to rely on modeling and looking at the curvatures of the bladder and prostate. And of course, even when using a structure-specific automatic segmentation tool, the individual seeds must still be placed within each structure of interest.

Knowledge-Based Image Automatic Segmentation

FIG. 1 illustrates a knowledge-base 100 in accordance with an embodiment of the present invention. A knowledge base 100 comprises a plurality of reference image sets 102 a-102 n. Each reference image set 102 a-102 n comprises two-dimensional slices of a three-dimensional volume. Each reference image set 102 a-102 n further comprises meta-data, possibly including a sparse landmark signature corresponding to each reference image, and a plurality of segments and contours corresponding to structures of interest seen in each individual reference image slice.

In one exemplary embodiment a knowledge-base 100 initially comprises a plurality of expert cases. Each of these expert cases contains reference image sets 102 a-102 n with segmentations and contours that have been individually hand-drawn. Each structure of interest has been labeled.

In another embodiment of the knowledge-base 100, the initial plurality of reference image sets 102 a-102 n would share common characteristics. For example, each reference image set 102 a-102 n in the knowledge-base 100, would have a common characteristic in the meta-data, such as race, sex, diagnosis, treatment site, age, and size of patient, etc. A knowledge-base 100 used predominantly in the treatment of Asian patients would be different from a knowledge-base 100 used predominantly in the treatment of Europeans, for example. Similarly, a knowledge-base 100 used in an exclusively female practice would only need to comprise reference data sets 102 a-102 n of female patients.

FIG. 1 further illustrates a medical image processing module 110. The medical image processing module 110 receives an image set for a current patient called a medical image set 112. The medical image processing module 110 processes the medical image set 112 to reduce each image slice to a sparse landmark signature. The end result is a sparse landmark signature set 114. In an embodiment, the sparse landmark signature may be computed for the entire image set, rather than for each individual slice.

A sparse landmark signature based on a medical image slice will allow much of the information contained in a medical image set to be ignored. Rather than running the algorithms pixel by pixel across each slice of a medical image set 112, which would consume an excessive amount of computational time and resources, a sparse landmark signature reduces the individual slices to only a collection of points for further processing.

For example, a medical image set 112 of a male patient with prostate cancer would have a particular sparse landmark signature set 114. If the diagnosis is prostate cancer, the three-dimensional volume of the medical image set 112 is the middle of the body. Because the pelvic girdle defines the location of the prostate, the individual slices are scanned from top to bottom, looking for the first instance of bone (image pixels of bright intensity). This is accomplished for both sides of the pelvic girdle, allowing the location of the femoral heads to be identified. Next, the point where the pelvic girdle ends is also located. The prostate can be found by triangulating from those three points.

As further illustrated in FIG. 1, after the sparse landmark signature set 114 of the medical image set 112 is generated, reference image sets 102 a-102 n can be selected based upon their similarities to the present patient medical image set 112 and the corresponding sparse landmark signature set 114. In an exemplary embodiment of the present invention, a plurality of reference image sets 102 a-102 n is selected. Exemplary embodiments can select from as few as one reference image sets 102 a-102 n to as many as ten or more reference image sets 102 a-102 n. In one exemplary embodiment, three reference image sets 102 a-102 c are selected. The selected reference image sets 102 a-102 c become a base set 116.

In an exemplary embodiment of the present invention, the medical image processing module 110 begins the reference image set 102 a-102 n selection process by reviewing meta-data attached to the current medical image set 112. As is well known in the art, meta-data may include information associated with a particular patient at a very high level that is not especially personalized. It would include such details as: age, sex, diagnosis, weight, whether or not there is nodal involvement, any co-morbidities, treatment site, side of the body, and approximate location of tumor. The available meta-data attached to the current medical image set 112 is used to start a search through the knowledge-base, reviewing the meta-data attached to reference image sets 102 a-102 n for corresponding matches. Through the use of meta-data, the knowledge-base can be sorted so that in an exemplary medical image set with meta-data identifying a male patient with advanced lung cancer, only reference image sets of males with lung tumors on the same side of the body are reviewed. From the knowledge-base, the top reference image set 102 a-102 c matches are selected based upon their similarities to the present medical image set 112 meta-data and sparse landmark signature.

A base set 116 contains as noted above in exemplary embodiments, anywhere from one to ten or more reference image sets 102 a-102 n. A plurality of reference image sets 102 a-102 n are selected to reduce the error inherent in each individual reference image set 102 a-102 n. It is obvious that a single reference image set 102 a-102 n won't be a perfect match; there will be some disagreement between the reference image set 102 a-102 n and the medical image set 112. A plurality of reference image sets 102 a-102 n in the base set 116 allows the formation of a statistical model to serve as a reference image.

In an exemplary embodiment of the present invention, each of the selected reference images sets 102 a-102 c in the base set (in this exemplary embodiment, three reference cases are selected) are individually deformed to the medical image set. In other words, the points in the sparse landmark signature of each reference image set 102 a-102 c (one slice at a time) are deformed to the points in the sparse landmark signature set 114 of the medical image set 112. In one exemplary embodiment, a deformable image registration algorithm will take the selected reference image sets 102 a-102 c and the medical image set 112 which has no segmentation or contouring and morph each of the reference image sets 102 a-102 c one at a time, and one slice at a time, to look like the medical image set 112. The registration algorithm will also transfer the contours from each reference image set 102 a-102 c to the medical image set 112 as well. The contours are each transferred along with the labels. By deforming each of the three selected reference image sets 102 a-102 c to the medical image set 112, the contours that were tagged to a pixel will also move as the pixels move. Each of the points from each of the reference image sets 102 a-102 c are deformed to the points of the medical image set 112. In another embodiment of the present invention, a portion of the selected reference image sets 102 a-102 n in the base set are deformed to the medical image set. This portion can be one or more of the reference image sets 102 a-102 n.

As multiple reference image sets 102 a-102 c are individually deformed to the medical image set 112, exemplary embodiments of the present invention are therefore using a statistical-based algorithm, instead of only an image-based algorithm. By taking the results coming from the deformation of the three reference image sets 102 a-102 n to the medical image set 112 and averaging them, statistical processing will provide a final result that is an average of the three (or whatever number is chosen) reference images 102 a-102 c. It's more statistically likely that the average for the three top references will converge on a more correct answer than that any one of them will be individually correct. As illustrated in FIG. 1, the medical image processing module will therefore deform the base set 116 to the sparse landmark signature 114 of the medical image set 112 to create a statistical model 118 containing segmentation and contouring of the structures of interest in the medical image set 112.

In an exemplary embodiment, weighted-average segmentation is thereby provided to create the statistical model 118. If all three reference image sets 102 a-102 c agree very well, then a simple average of the three will be sufficient. But if two of them agree closely and the third had an outlier (e.g., a contour or segmentation result for a particular structure of interest is different from the other results), the third result's outlier could be de-emphasized in the statistical model 118, making the assumption that the outlier is incorrect. Weighted-average segmentation for example, would look at the standard deviation of the results for each of the structures of interest that are identified in the statistical model 118. A simple method of weighting the results when an outlier appears would be to discard the outlier result. It should be noted that the statistical weighted-averaging is not applied to the patient, i.e., medical image set 112, but to each of the resulting structures of interest within the medical image set 112. In other words, in an exemplary embodiment there can be as many weighted mixes between the three reference image sets 102 a-102 c as there are structures of interest. The statistical model 118 therefore provides a good starting point for further segmentation processing. The statistical model can with a certain amount of statistical certainty, identify what is prostate or lung for example, even if each of the individual outline contours isn't perfect. That is, at least what is inside the contour has been identified as prostate or lung, as the case may be.

In an exemplary embodiment, when the weighted-average segmentation provided to the statistical model 118 is not approved by the practitioner, additional reference image sets that likewise contain common meta-data characteristics and similar sparse landmark signatures will be selected and added to the base set 116 to be registered (i.e., deformed) to the medical image set 112. In an exemplary embodiment, the additional reference image sets are added one at a time. Again, as discussed above, the sparse landmark signature of the newly added reference image set would also be deformed to the sparse landmark signature of the medical image set as the original three reference image sets were. After statistical processing, an updated weighted-average segmentation is provided to the statistical model 118 for review by the practitioner. Additional reference image sets can be added to the base set 116 as required, as long as additional candidate reference image sets remain in the knowledge-base 100, and their addition to the base set 116 continues to improve the weighted-average segmentation of the statistical model 118.

Further, statistical parameters of the statistical model 118 may also be evaluated, by looking at non-image based components from the reference image sets (shape, volume, smoothness, density, etc.) and thereby refine the resulting statistical model 118 and updated statistical model 120.

Knowledge-Based Image Sub-Volume Segmentation

In an exemplary embodiment, the process described above for a medical image set 112 and a base set 116 comprising a plurality of reference image sets 102 a-102 n is repeated for a plurality of structures of interest or “sub-volumes” of the medical image set from a plurality of patient cases in the knowledge-base, as illustrated in FIG. 4. A sub-volume will typically contain only a single structure of interest rather than all of the structures of interest found in the medical image set. A plurality of reference image set sub-volumes 402 a-402 n, grouped as sub-volume base sets 416 a-416 n, for each identified structure of interest 412 a-412 n of the medical image set 112 is selected. In other words, a plurality of reference image set sub-volumes 402 a-402 n are selected for each sub-volume (i.e., structure of interest) of the medical image set. For example, for a medical image set sub-volume for the prostate, a plurality of prostate sub-volumes from reference image sets will be selected. In other words, rather than entire reference image sets 102 a-102 n, only a prostate sub-volume 412 a-412 n of the reference image sets 102 a-102 n would be selected. Again, in an exemplary embodiment, the number is three. Each plurality of reference image set sub-volumes is therefore a sub-volume base set for a particular structure of interest. There can be a sub-volume base set 416 for each structure of interest 412 in the medical image set 112.

As described above for reference image sets 102 a-102 n and the medical image set 112, in the same manner, each reference image set sub-volume 402 is deformed to a corresponding structure of interest 412 of the medical image set 112, just as each reference image set 102 is deformed to the medical image set 112. Further, as described above, in another embodiment of the present invention, a portion of the selected reference image sets sub-volumes 402 a-402 n in the plurality of sub-volume base sets 416 are deformed to the structures of interest 412 a-412 n in the medical image set 112. This portion can again be one or more of the reference image set sub-volumes 402 a-402 n. After a weighted-average segmentation for each structure of interest in the medical image set 112 is completed as described above, each structure of interest or sub-volume 412 a-412 n would also have a corresponding sparse landmark signature set 414 that is also a portion of the sparse landmark signature set 114 of the medical image set 112. By selecting particular structures of interest 402 (i.e., the best candidates) of reference image sets 102 (and their corresponding sparse landmark signatures 414 for the structures of interest) to deform to the corresponding structure of interest 412 in the medical image set 112 (and its corresponding sparse landmark signature 414), the resulting weighted-average segmentation of each structure of interest 412 a-412 n used to create the statistical model 118 can be further improved. This is because rather than seeking for a reference image set 102 candidate that is a good all-around match to the patient anatomy, only the individual sub-volumes 402 or structures of interest are considered. Therefore, a reference image set 102 that would not be a good candidate for all structures of interest can still be a good sub-volume candidate.

Continuous Knowledge-Base Improvement

However, to get better results with the knowledge-base 100, additional reference image sets need to be added to the knowledge-base 100. In other words, additional clinical cases with their patient specific meta-data, medical image sets, sparse landmark signatures, statistical models can be added to the knowledge base after the practitioner has completed the patient-specific treatment plan and approved the segmentation and contouring of the structures of interest in the medical image set. After the practitioner has reviewed, edited (as needed), and approved the segmentation results, the subject patient's information can become a new reference image set with its own attached meta-data and treatment information to be placed in the knowledge-base to increase the number of candidate reference image sets available. This new reference image set will then be available to be reused as part of a base set the next time there is a patient with similar meta-data, etc. Even with very personalized, patient-specific medicine, these described processes allow the creation of a closed loop: each iteration of the process allows the addition of a new reference image set 102 to the knowledge-base. Therefore, as more reference image sets 102 are added to the knowledge-base 100, the more robust the knowledge-base 100 becomes, with improved statistical modeling and better end results. As more reference image sets 102 are placed into the knowledge-base 100, the searches can be further refined and based on additional criteria to ensure that the selected reference image sets 102 a-102 n are close matches to the medical image set 112.

Statistical Model Used as a Seed

In an exemplary embodiment, the statistical model 118 with its weighted-average segmentation of each structure of interest can be used as a seed itself. Rather than traditional structure-specific segmentation tools requiring manually selected seeds before the processing begins, the seeds can be provided by the identified structures of interest from the statistical model 118. By providing seeds that are statistically probable to be drawn in pixels inside the structure of interest, it allows any of the previously discussed segmentation methods to begin with improved seed selections. Further, using the statistical model's weighted-average segmentation of structures of interest allows these other segmentation methods to avoid having to start from scratch.

While there is no guarantee that a structure of interest will be segmented correctly, there is a good statistical possibility that a cluster of pixels in the middle of the segmentation of the structure of interest will be within that actual structure of interest. In an exemplary embodiment, this central cluster of statistically significant pixels is then used as the “seed” for other automatic segmentation algorithms.

In an exemplary embodiment, as illustrated in FIG. 1, and described in more detail below, the statistical model 118 is used as a seed for deformable image registration and to drive the autosegmentation component of structure-specific automatic segmentation tools 130 a-130 n. In an exemplary embodiment, the automatic segmentation tools 130 a-130 n can be either structure-specific segmentation tools or non-structure-specific segmentation tools. When the segmentation results are returned by the automatic segmentation tools 130 a-130 n to the medical image processing module 110 the results can be used to create an updated statistical model 120 that comprises weighted-average segmentation of each structure of interest in the medical image set 112, as discussed in detail below.

The automatic segmentation tools 130 a-130 n use the seed provided by the statistical model 118 to calculate the segmentation of one or more structures of interest. These structure-specific segmentation algorithms can use a structure-specific model to aid in completing the segmentation that will look at all the data within the image that has been labeled as a seed for the structure of interest (e.g., the prostate or lung). This gives the structure-specific algorithm a very good starting point. The structure-specific algorithms work best when they are working on the specific structures they are designed to segment.

The statistical weighted averaging can also be extended to statistically weighted-averaging of these different algorithms depending on their abilities and whether there is something about the particular meta-data or the image that would make one algorithm more accurate than another. This allows the results from a plurality of algorithms to be averaged to arrive at an even more statistically accurate definition of a structure of interest by comparing the results from a plurality of structure-specific algorithms. The end result would be the medical image processing module calculating an updated statistical model 120 that comprises a weighted-average segmentation of each structure of interest in the medical image set 112. As discussed above, this updated statistical model 120 after being reviewed, editing, and finally approved by the practitioner for use with the current patient, may be added to the knowledge-base as a new reference image set 102.

Knowledge-Based Autosegmentation Algorithm Improvements

In an exemplary embodiment, the above described processes can include an update to the statistical tools, by performing a difference calculation. The difference calculation compares what the system calculated to what was ultimately accepted by the practitioner, identifies the point(s) that failed, and acts to modify the behavior of the algorithm. By back-projecting the difference, changes are made to the algorithm parameterization until an optimal solution results for the individual patient case. Weighting functions can be adjusted to reach the optimal results. The patient specific parameterizations can then be incorporated into a population-parameterization of each algorithm.

In other words, if the system was failing to recognize a pelvis case, for instance, the selection of sparse landmarks would have to be adjusted so that a pelvis case is properly recognized. In another example, the way that deformable image registration is identifying a structure of interest may have to be changed if the location is correct, but the segmentation/contour result is incorrect. For example, if a gap exists between the computed and hand-drawn edge of an organ of interest, then the edge detection algorithm can be adjusted to correct it. Knowing where the gap was and where the correction was made, the correction can be worked into the particular algorithm to improve it. If a segmentation algorithm fails similarly throughout a population of patients, its weighting factor for the identified failure mode would be decreased when computing a weighted average between different segmentation algorithms.

Knowledge-Based Autosegmentation Processes

FIG. 2 illustrates the steps of a process in accordance with an embodiment of the present invention. Where the process includes steps that have already been explained in detail, they will not be repeated here. In step 202, a new medical image set 112 is loaded. The medical image set 112 may be loaded into the memory of a computer system. In step 204, landmark features (i.e., points on the medical image set 112) are extracted to create a sparse landmark signature 114.

In step 206, a knowledge-base 100 is scanned to search for reference image sets 102 a-102 n with similar sparse landmark signatures 114 and similar meta-data. In an exemplary embodiment, the sparse landmark signatures 114 serve as an index for the knowledge-base 100. In step 208, n reference image sets 102 a-102 n are selected to form a base set 116. In an exemplary embodiment, n=3. In step 210, a portion of the reference image sets 102 a-102 n are registered to the medical image set 112. This portion can be two or more of the selected reference image sets 102 a-102 n. In one exemplary embodiment, all of the selected reference image sets 102 a-102 n are registered. By deforming the reference image set to the medical image, the segmented and contoured structures of interest in the reference image set are also applied to the medical image set.

In step 212, a weighted average structure-specific segmentation is completed to form the statistical model 118. In other words, weighted averages are calculated for each structure to reach a weighted-average structure segmentation. As noted above, the statistical model 118 may now serve as a seed for use in other segmentation tools, including those that are structure-specific.

In step 214, the practitioner or user reviews, edits and approves the segmentation results. In step 216, structure-specific statistical parameters are computed and improved when possible (by looking at non-image based components from the reference image sets (shape, volume, smoothness, density, etc.). Then in step 218, the knowledge-base is updated with the medical image set 112 and its corresponding structure set (statistical model 118), sparse landmark signature set 114, and meta-data as a new reference image set 102.

FIG. 3 illustrates the steps of a process in accordance with an embodiment of the present invention. Where the process includes steps that have already been explained in detail, they will not be repeated here. Step 302 begins after a statistical model 118 has been calculated. In step 302, statistical parameters describing each segmented structure of interest are further evaluated. In step 304, sub-volumes 412 a-412 n from the medical image set 112, wherein a sub-volume contains or is a structure of interest, are loaded into the computer for processing. These sub-volumes 412 a-412 n are the structures of interest with their own sparse landmark signatures 414 that have already been segmented in FIG. 2, as described above. In other words, each sub-volume comprises 412 a-412 n a sub-volume sparse landmark signature 414. In step 306, n reference image set sub-volumes 402 a-402 n are loaded for each structure of interest (i.e., sub-volume) in the medical image set 112 to form corresponding sub-volume base sets 416 a-416 n. In one embodiment, n=3. Each of the reference image set sub-volumes 402 a-402 c of the plurality of sub-volume base sets 416 a-416 n is selected for a corresponding structure of interest 412 a-412 n in the medical image. In one embodiment, each reference image set sub-volume 402 can come from a different reference image set 102. In other words, if there are fifteen structures of interest in the medical image set 112, then there will be forty-five reference image sets 102 a-102 n providing the necessary forty-five reference image set sub-volumes 402 a-402 n contained in the fifteen sub-volume base sets 416 a-416 n. In another embodiment, a single reference set 102 can provide a plurality of reference image set sub-volumes 402 a-402 n.

In step 308, a portion of the reference image set sub-volumes 402 a-402 n and their segmented and contoured structures of interest are deformed or registered to the corresponding structure of interest 412 a-412 n of the medical image set 112. This portion can be two or more of the selected reference image sets 402 a-402 n. In one exemplary embodiment, all of the selected reference image set sub-volumes 402 a-402 n are registered or deformed. With the reference image set sub-volumes 402 a-402 n from each sub-volume base set 416 a-416 n deforming to the corresponding structure of interest 412 a-412 n of the medical image set 112. In step 310, a weighted-average segmentation value is calculated for each structure of interest 412 a-412 n in the medical image set 112. Calculating the weighted-average segmentation value for each structure of interest 412 a-412 n in the medical image set 112 allows the calculation of an updated statistical model 118.

In step 312 each structure of interest 412 a-412 n in the statistical model 118 is used as a seed and each post-processed by a plurality of structure-specific segmentation tools. Each structure of interest segmentation is used as a seed for a plurality of structure-specific segmentation tools. In step 314, a weighted-average segmentation result is calculated for each structure of interest based upon the segmentation results for each structure of interest 412 a-412 n provided by the structure-specific segmentation tools. As mentioned above, this weighted-average segmentation result for each structure of interest 412 a-412 n is the updated statistical model 120.

In step 316, the practitioner or user reviews, edits and approves the weighted-average segmentation results from step 314. In step 318, structure-specific statistical parameters are computed and improved when possible (by looking at non-image based components from the reference image sets (shape, volume, smoothness, density, etc.). Then in step 320, the knowledge-base is updated with the medical image set 112 and its corresponding structure set (statistical model 120), sparse landmark signature 114, and meta-data as a new reference image set 102.

FIG. 5 illustrates the steps of a process in accordance with an embodiment of the present invention. In step 502, a cohort of patients or reference image sets 102 a-102 n within the knowledge-base are selected that share common characteristics. These common characteristics can include diagnosis, sex, age, race, treatment site, etc. In step 504, all members of the cohort are deformed into a single aggregated dataset, forming a single representative case. In step 506, geometric analysis is performed on the radiation therapy for structures of interest and the associated radiation therapy doses. In step 508, cohort representatives are compared to other cohort representative cases.

Individual and Cohort Average Image Automatic Segmentation

In further embodiments, as illustrated in FIGS. 6 and 8, rather than selecting a plurality of reference image sets 102 a-102 n to form a base set 116, a single reference image set 102 may be selected and registered to the medical image set 112 to form a segmented image 602. In a further embodiment, as illustrated in FIGS. 7 and 9, rather than selecting a plurality of reference image sets 102 a-102 n that are then individually registered to the medical image set 112 to form a statistical model 118 based upon the weighted-average segmentation of the individually registered plurality of reference image sets 102 a-102 n, a cohort average reference image set 702 is selected and registered to the medical image set 112 to form a segmented image 602. As described below, a cohort average reference image set 702 is a reference image set 102 that is an average of all or part of the reference image sets 102 a-102 n in a cohort.

As illustrated in FIG. 6, and further illustrated in FIG. 1, after the sparse landmark signature set 114 of the medical image set 112 is generated, a reference image set 102 can be selected based upon its similarities to the present patient medical image set 112 and the corresponding sparse landmark signature set 114. In an exemplary embodiment of the present invention, the medical image processing module 110 begins the reference image set 102 selection process by reviewing meta-data attached to the current medical image set 112. As is well known in the art, meta-data may include information associated with a particular patient at a very high level that is not especially personalized. It would include such details as: sex, age, diagnosis, height, weight, whether or not there is nodal involvement, any co-morbidities, treatment site, side of the body, and approximate location of the tumor, to name but a few. For example, a cohort may comprise reference image sets 102 a-102 n contained within a specified weight range (e.g., 160-200 pounds). As discussed above, the available meta-data attached to the current medical image set 112 is used to start a search through the knowledge-base, including reviewing the meta-data attached to reference image sets 102 a-102 n for corresponding matches. In one embodiment, the associated reference image sets 102 a-102 n of a selected cohort are searched. As discussed above, a selected cohort would contain reference image sets 102 a-102 n with at least one common characteristic. In other words, first a particular cohort would be selected, and then a reference image set 102 contained in the selected cohort will be selected. A reference image set 102 in the selected cohort can be selected based upon its similarities to the present patient medical image set 112 and the corresponding sparse landmark signature set 114. In an additional embodiment, rather than selecting a “best match” reference image set 102, a reference image set 102 in the knowledge-base is selected randomly. In additional embodiments, a randomly selected reference image set 102 is randomly selected from the reference image sets 102 a-102 n in a selected cohort.

In an exemplary embodiment of the present invention, the selected reference image set 102 is deformed to the medical image set. In other words, the points of the sparse landmark signature of the reference image set 102 (one slice at a time) is deformed to the points in the sparse landmark signature 114 of the medical image set 112. In one exemplary embodiment, a deformable image registration algorithm will take the selected reference image set 102 and the medical image set 112, which has no segmentation or contouring, and morph the reference image set, one slice at a time, to look like the medical image set 112. The registration algorithm will also transfer the contours from the selected reference image set 102 to the medical image set 112 as well. The contours are each transferred along with the labels. By deforming the selected reference image set 102 to the medical image set 112, the contours that were tagged with a pixel will also move as the pixels move. Each of the points from the selected reference image set 102 is deformed to the points of the medical image set 112. In another embodiment of the present invention, a portion of the selected reference image set 102 is deformed to the medical image set 112. As discussed above, and illustrated in FIG. 1, the medical image processing module will therefore deform the selected reference image set 102 to the sparse landmark signature 114 of the medical image set 112 to create a segmented image 602, as illustrated in FIG. 6, containing segmentation and contouring of the structures of interest in the medical image set 112.

Further, parameters of the segmented image 602 can also be evaluated, by looking at non-image based components from the reference image set 102 (shape, volume, smoothness, density, etc.) and thereby refine the resulting segmented image 602.

In the exemplary embodiment discussed above for knowledge-based image sub-volume segmentation, the process described above for a medical image set and a base set 116 comprising a plurality of reference image sets 102 a-102 n, is performed for a plurality of structures of interest or “sub volumes” of the segmented medical image set 602 from a plurality of patient cases in the knowledge-base, as illustrated in FIG. 4, and discussed in detail above.

A process for registering a selected reference image set 102 to the medical image set 112 is illustrated in FIG. 8. In step 802, a new medical image set 112 is loaded into the medical image processing module 110. In step 804, landmark features are extracted from the medical image set 112 to create a sparse landmark signature. In step 806, the knowledge-base is scanned for cases with similar sparse signatures and meta-data. As discussed above, the entire knowledge-base may be scanned, or the reference image sets 102 a-102 n of a selected cohort may be scanned. In step 808, a single, “best-match” reference image set 102 is selected and loaded into the medical image processing module 110. In step 810, the best match reference image set 102 is registered (deformed or affined) to the medical image set 112 along with structures of interest. In step 812, the user reviews the segmentation results, edits the segmentation result and approves the final segmentation result. In step 814, structure-specific statistical parameters are computed as discussed above. Finally, in step 816, the knowledge-base is updated with the medical image set 112 and the corresponding structure set.

In a further embodiment, rather than individually registering selected reference image sets 102 a-102 n to the medical image set 112 and calculating a weighted-average based statistical model 118 as discussed in detail above, a cohort average reference image set 702 may be selected from the knowledge base. In an embodiment of the present invention, each cohort contains at least one cohort average reference image set 702 corresponding to the reference image sets 102 a-102 n in the cohort. In other words, each of the reference images sets 102 a-102 n in a cohort are averaged to create a reference image set that is an average of all the reference image sets in the particular cohort. Such a cohort average reference image set 702 may be an average of all of the reference image sets 102 a-102 n in a cohort, or just a selected portion of them. In a further embodiment, there can be a cohort average reference image set 702 that is an average of all the reference image sets 102 a-102 n in the knowledge base or of a portion of the reference image sets 102 a-102 n in the knowledge base. In other words, a hundred or more (e.g., 1000) reference image sets 102 a-102 n may be averaged together to produce a cohort average reference image set 702 that is an average of all the reference image sets in the knowledge base, or a statistically significant portion of them. It is appreciated that a cohort average reference image set 702 for each cohort or portions of the knowledge-base are exemplary in nature and not intended to limit the scope of the present invention.

As illustrated in FIG. 7, and further illustrated in FIG. 1, after the sparse landmark signature set 114 of the medical image set 112 is generated, a cohort of reference image sets 102 a-102 n can be selected based upon its similarities to the present patient medical image set 112 and the corresponding sparse landmark signature set 114. In other words, a cohort can be selected based upon the similarities of its cohort average reference image set 702 to the present patient medical image set 112 and the corresponding sparse landmark signature set 114. In an exemplary embodiment of the present invention, the medical image processing module 110 begins the cohort selection process by reviewing meta-data attached to the current medical image set 112. As is well known in the art, meta-data may include information associated with a particular patient at a very high level that is not especially personalized. It would include such details as: sex, age, diagnosis, height, weight, whether or not there is nodal involvement, any co-morbidities, treatment site, side of the body, and approximate location of the tumor, to name but a few. For example, a cohort may comprise reference image sets 102 a-102 n contained within a specified weight range (e.g., 160-200 pounds). As discussed above, the available meta-data attached to the current medical image set 112 is used to start a search through the knowledge-base, reviewing the meta-data attached to cohorts of reference image sets 102 a-102 n for corresponding matches. As discussed above, a selected cohort would contain reference image sets 102 a-102 n with at least one common characteristic. Once a cohort is selected, the cohort average reference image set 702 of the selected cohort is loaded into the medical image processing module 110. As discussed above, rather than selecting a cohort average reference image set 702 corresponding to a particular cohort, a cohort average reference image set 702 may be selected that is an average of all or only a portion of the reference image sets 102 a-102 n in the knowledge base.

In an exemplary embodiment of the present invention, the selected cohort average reference image set 702 is deformed to the medical image set. In other words, the points of the sparse landmark signature of the cohort average reference image set 702 (one slice at a time) are deformed to the points in the sparse landmark signature 114 of the medical image set 112. In one exemplary embodiment, a deformable image registration algorithm will take the selected cohort average reference image set 702 and the medical image set 112, which has no segmentation or contouring, and morph the reference image set, one slice at a time, to look like the medical image set 112. The registration algorithm will also transfer the contours from the selected cohort average reference image set 702 to the medical image set 112 as well. The contours are each transferred along with the labels. By deforming the selected cohort average reference image set 702 to the medical image set 112, the contours that were tagged with a pixel will also move as the pixels move. Each of the points from the selected cohort average reference image set 702 are deformed to the points of the medical image set 112.

In another embodiment of the present invention, a portion of the selected cohort average reference image set 702 is deformed to the medical image set 112. As discussed above, and illustrated in FIG. 1, the medical image processing module will therefore deform the selected cohort average reference image set 702 to the sparse landmark signature 114 of the medical image set 112 to create a segmented image 602, as illustrated in FIG. 7, containing segmentation and contouring of the structures of interest in the medical image set 112. In another embodiment, the statistical average of all the reference image sets in a cohort of reference image sets within the knowledge-base are determined by determining a statistical average of a quantity of deformably or affinely registered reference image sets in the cohort, wherein the quantity of reference image sets is one of a portion of the reference image sets in the cohort and all the reference image sets in the cohort, and determining a statistical average of a quantity of deformably or affinely registered reference image sets in the knowledge-base, wherein the quantity of reference image sets is one of a portion of the reference image sets in the knowledge-base and all the reference image sets in the knowledge-base.

As discussed above, parameters of the segmented image 602 can also be evaluated, by looking at non-image based components from the cohort average reference image set 702 (shape, volume, smoothness, density, etc.) and thereby refine the resulting segmented image 602.

In the exemplary embodiment discussed above for knowledge-based image sub-volume segmentation, the process described above for a medical image set and a base set 116 comprising a plurality of reference image sets 102 a-10 n, is performed for a plurality of structures of interest or “sub volumes” of the segmented medical image set 602 from a plurality of patient cases in the knowledge-base, as illustrated in FIG. 4, and discussed in detail above.

A process for registering a selected cohort average reference image set 702 to the medical image set 112 is illustrated in FIG. 9. In step 902, a new medical image set 112 is loaded into the medical image processing module 110. In step 904, landmark features are extracted from the medical image set 112 to create a sparse landmark signature. In step 906, the knowledge-base is scanned for a cohort with similar sparse signatures and meta-data. In step 908, a cohort average reference image set 702 from the selected cohort is loaded into the medical image processing module 110. In step 910, the cohort average reference image set 702 is registered (deformed) to the medical image set 112 along with structures of interest. In step 912, the user reviews the segmentation results, edits the segmentation result and approves the final segmentation result. In step 914, structure-specific statistical parameters are computed as discussed above. Finally, in step 916, the knowledge-base is updated with the medical image set 112 and the corresponding structure set.

Although certain preferred embodiments and methods have been disclosed herein, it will be apparent from the foregoing disclosure to those skilled in the art that variations and modifications of such embodiments and methods may be made without departing from the spirit and scope of the invention. It is intended that the invention shall be limited only to the extent required by the appended claims and the rules and principles of applicable law. 

What is claimed is:
 1. A method for segmenting an image data set, the method comprising: accessing, from a knowledge-base, a plurality of reference image sets in a cohort; creating a cohort average reference image set that includes an average of each reference image set in the plurality of reference image sets in the cohort; deformably or affinely registering the cohort average reference image set to a first medical image set; generating a statistical model based on the deformably or affinely registered cohort average reference image set, the statistical model comprising contours and segmentation of a plurality of structures of interest in the first medical image set; and determining a segmentation for the plurality of structures of interest in a second medical image set based upon the statistical model.
 2. The method of claim 1, wherein said determining comprises using the statistical model as a seed for at least one structure-specific segmentation algorithm.
 3. The method of claim 1, wherein the cohort of reference image sets comprises reference image sets within the knowledge-base that share a common characteristic selected from the group consisting of: weight, sex, diagnosis, stage, responder versus non-responders, age, treatment site, and size.
 4. The method of claim 1, further comprising computing a sparse landmark signature based on the first medical image set, wherein the sparse landmark signature comprises a plurality of points.
 5. The method of claim 4, wherein said registering comprises deforming points of a sparse landmark signature of the cohort average reference image set to the points of the sparse landmark signature of the first medical image set.
 6. The method of claim 4, wherein said accessing comprises: comparing meta-data from the first medical image set to meta-data of reference image sets in the knowledge-base; and comparing sparse landmark signatures of the first medical image set to sparse landmark signatures of the reference image sets in the knowledge-base.
 7. The method of claim 1, further comprising updating a plurality of statistical analysis tools that determine the segmentation.
 8. The method of claim 1, wherein said registering comprises deforming the cohort average reference image set with a deformable image registration algorithm.
 9. The method of claim 1, further comprising adding an approved medical image set and corresponding structures of interest to the knowledge-base as a new reference image set, wherein the approved medical image set comprises segmented structures of interest from the first medical image set.
 10. The method of claim 1, wherein said accessing comprises one of: randomly selecting a reference image set from a cohort of reference image sets in the knowledge-base, wherein the knowledge-base contains at least one cohort; randomly selecting a reference image set from the knowledge-base; comparing sparse landmark signatures of the first medical image set to sparse landmark signatures of reference image sets in the knowledge-base; and comparing meta-data from the first medical image set to meta-data of reference image sets in the knowledge-base.
 11. A method for segmenting image data sets, comprising: accessing a medical image set for a patient; accessing a cohort average reference image set from a knowledge-base, wherein the cohort average reference image set is generated by accessing, from the knowledge-base, a plurality of reference image sets in a cohort and averaging each reference image set in the plurality of reference image sets in the cohort; deformably or affinely registering the cohort average reference image set to the first medical image set; generating a statistical model based on the deformably or affinely registered cohort average reference image set, the statistical model comprising contours and segmentation of a plurality of structures of interest in the first medical image set; and determining a segmentation for the plurality of structures of interest in a second medical image set based upon the statistical model.
 12. The method of claim 11, wherein said determining comprises using the statistical model as a seed for at least one structure-specific segmentation algorithm.
 13. The method of claim 11, further comprising computing a sparse landmark signature based on the first medical image set, wherein the sparse landmark signature comprises a plurality of points.
 14. The method of claim 13, wherein said registering comprises deforming points of a sparse landmark signature of the cohort average reference image sets to the points of the sparse landmark signature of the first medical image set.
 15. The method of claim 11, further comprising updating a plurality of statistical analysis tools that determine the segmentation.
 16. The method of claim 11, wherein said registering comprises deforming the cohort average reference image set with a deformable image registration algorithm.
 17. The method of claim 11, wherein said registering comprises deforming segmented structures of interest from the portion of the cohort average reference image set to the first medical image set.
 18. The method of claim 11, further comprising adding an approved medical image set and corresponding structures of interest to the knowledge-base as a new reference image set, wherein the approved medical image set comprises segmented structures of interest from the first medical image set.
 19. A method for segmenting image data sets, comprising: accessing a first medical image set; accessing, from the knowledge-base, a plurality of reference image sets in a cohort; searching the plurality of reference image sets in the cohort to form a sub-volume base set comprising a plurality of reference image sets for a structure of interest in the first medical image set; creating an average reference image set that includes an average of each reference image set of the plurality of reference image sets in the sub-volume base set; deformably or affinely registering the average reference image set to the first medical image set; generating a statistical model based on the deformably or affinely registered average reference image set, the statistical model comprising contours and segmentation of the structure of interest in the first medical image set; and determining a segmentation for the structure of interest in a second medical image set based upon the statistical model.
 20. The method of claim 19, wherein said determining comprises using the statistical model as a seed for at least one structure-specific segmentation algorithm.
 21. The method of claim 19, wherein the cohort of reference image sets comprises reference images sets within the knowledge-base that share a common characteristic selected from the group consisting of: weight, sex, diagnosis, stage, responder versus non-responders, age, treatment site, and size.
 22. The method of claim 19, wherein said registering comprises deforming points of a plurality of sparse landmark signatures of the average reference image set to points in a corresponding sparse landmark signature of the structure of interest of the first medical image set.
 23. The method of claim 19, wherein said searching comprises: comparing meta-data from the first medical image set to meta-data of reference image sets in the knowledge-base; and comparing a sparse landmark signature of the structure of interest of the first medical image set to sparse landmark signatures of corresponding structures of interest of the reference image sets in the knowledge-base.
 24. The method of claim 19, further comprising computing a sparse landmark signature based on the first medical image set, wherein the sparse landmark signature comprises a plurality of points.
 25. The method of claim 19, further comprising updating a plurality of statistical analysis tools that determine the segmentation.
 26. The method of claim 19, further comprising adding an approved medical image set and corresponding structures of interest to the knowledge-base as a new reference image set, wherein the approved medical image set comprises the segmented structure of interest from the first medical image set. 